eComment: A limited antero-lateral minithoracotomy for congenital ventricular septal defects repair in adult patients

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S.-H. Jung et al. / Interactive CardioVascular and Thoracic Surgery 10 (2010) 22–26

protection. Incisions were made on the right ventricular outflow tract. In adult patients with restrictive VSDs, MICS using minithoracotomy was safe and effective in selected patients type I, II or III VSD. Meticulous preoperative examination for the accurate diagnosis of VSD type is mandatory for successful outcomes. References w1x Tatebe S, Eguchi S, Miyamura H, Nakazawa S, Watanabe H, Sugawara M, Hayashi J, Date K, Nakagawa S. Limited vertical skin incision for median sternotomy. Ann Thorac Surg 1992;54:787–788. w2x Bedard P, Keon WJ, Brais MP, Goldstein W. Submammary skin incision as a cosmetic approach to median sternotomy. Ann Thorac Surg 1986;41:339–341. w3x Nicholson IA, Bichell DP, Bacha EA, del Nido PJ. Minimal sternotomy approach for congenital heart operations. Ann Thorac Surg 2001;71: 469–472. w4x Yoshimura N, Yamaguchi M, Oshima Y, Oka S, Ootaki Y, Yoshida M. Repair of atrial septal defect through a right posterolateral thoracotomy: a cosmetic approach for female patients. Ann Thorac Surg 2001; 72:2103–2105. w5x Chitwood WR Jr, Wixon CL, Elbeery JR, Moran JF, Chapman WH, Lust RM. Video-assisted minimally invasive mitral valve surgery. J Thorac Cardiovasc Surg 1997;114:773–782. w6x Chitwood WR Jr, Rodriguez E, Chu MW, Hassan A, Ferguson TB, Vos PW, Nifong LW. Robotic mitral valve repairs in 300 patients: a single-center experience. J Thorac Cardiovasc Surg 2008;136:436–441. w7x Giamberti A, Mazzera E, Di Chiara L, Ferretti E, Pasquini L, Di Donato RM. Right submammary minithoracotomy for repair of congenital heart defects. Eur J Cardiothorac Surg 2000;18:678–682. w8x Mavroudis C, Backer CL, Stewart RD, Heraty P. The case against minimally invasive cardiac surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005;193–197. w9x Svenarud P, Persson M, van der Linden J. Effect of CO2 insufflation on the number and behavior of air microemboli in open-heart surgery: a randomized clinical trial. Circulation 2004;109:1127–1132. w10x Martens S, Neumann K, Sodemann C, Deschka H, Wimmer-Greinecker G, Moritz A. Carbon dioxide field flooding reduces neurologic impairment after open heart surgery. Ann Thorac Surg 2008;85:543–547. w11x Lin PJ, Chang CH, Chu JJ, Liu HP, Tsai FC, Su WJ, Yang MW, Tan PP. Minimally invasive cardiac surgical techniques in the closure of ventricular septal defect: an alternative approach. Ann Thorac Surg 1998;65: 165–170.

eComment: A limited antero-lateral minithoracotomy for congenital ventricular septal defects repair in adult patients Authors: Jamshid H. Karimov, Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy; Mattia Glauber doi:10.1510/icvts.2009.215038A In this institutional report, the authors present their early experience in congenital ventricular septal defect repair in adult population using a minimally invasive technique w1x. Reading this paper some questions arise. You have mentioned the preoperative cardiac CT reconstruction; it would be interesting to know if you perform a CT-scan routinely for all patients scheduled for a minimally invasive approach and whether it is used for the identification of the 3rd

intercostal space only or you employ some special selection criteria for candidates for this approach based on their preoperative cardiac CT-scan? Do you use video assistance during the procedure or is direct vision sufficient for an adequate visualization? In our department, we always place a video camera, mainly for educational purposes (allowing a resident surgeon and operating team to follow the case) during a valve procedure in a minithoracotomy, as an operating surgeon performs the operation under direct vision. You have stated some drawbacks of antero-lateral minithoracotomy approach as for example a central aortic cannulation. In our opinion, a percutaneous venous cannula insertion and direct ascending aorta cannulation allows avoiding any additional complications associated with a peripheral cannulation. We employ a central aortic cannulation in all patients undergoing an isolated mitral or aortic valve surgery and double (mitralaortic and mitral-tricuspid) valve procedure w2x. We experienced just a few complications at the initial phase of our experience and method seemed feasible and safe in all consecutive patients. In our department, we perform a femoral artery cannulation in all redo operations, cases with deformated or deep chest, short ascending aorta. In this paper, Jung and associates report a safeness and effectiveness of the approach that serves to preserve the anatomic integrity of the chest wall, provide good cosmesis which are important qualities of this approach. References w1x Jung SH, Je HG, Choo SJ, Yun TJ, Chung CH, Lee JW. Right or left anterolateral minithoracotomy for repair of congenital ventricular septal defects in adult patients. Interact CardioVasc Thorac Surg 2010; 1:22–26. w2x Glauber M, Karimov JH, Farneti PA, Cerillo AG, Santarelli F, Ferrarini M, Del Sarto P, Murzi M, Solinas M. Minimally invasive mitral valve surgery via right minithoracotomy. Multimedia Man Cardiothorac Surg doi: 10.1510/mmcts.2008.003350.

eComment: Re: Right or left anterolateral minithoracotomy for repair of congenital ventricular septal defects in adult patients Authors: Leo A. Bockeria, Bakoulev Scientific Center for Cardiovascular Surgery, Roublevskoye Sh. 135, 121552 Russia; Alexey I. Kim, Dmitry V. Ryabtsev, Tigran R. Grigoryants doi:10.1510/icvts.2009.215038B Minimally invasive cardiac surgery has become an important field in recent years w1x. The main reasons for that were cosmetic result and economic effect w2x. However, there are some restrictions such as strict patient selection by weight and age or intra- and extracardiac pathology. Also, comprehensive preoperative diagnostics are important to determine surgical approach and prevent inadequate exposure. In addition, multifocal atherosclerosis may lead to non-relevant complication due to peripheral cannulation technique admission. On the other hand, the given results illustrate the correct patient selection with a perfect operative technique and cosmetic effect. References w1x Jung SH, Je HG, Choo SJ, Yun TJ, Chung CH, Lee JW. Right or left anterolateral minithoracotomy for repair of congenital ventricular septal defects in adult patients. Interact CardioVasc Thorac Surg 2010; 1:22–26. w2x Sebastian VA, Guleserian KJ, Leonard SR, Forbess JM. Ministernotomy for repair of congenital cardiac disease. Interact CardioVasc Thorac Surg 2009;9:819–822.